The True Obamacare Test

On a road trip through Ohio a few weeks ago, I stopped at a gas-station market, where a bulletin board outside the restrooms was covered with flyers. Somebody was selling black-and-white piglets; a pumpkin patch was offering hayrides. And there were several handmade leaflets fund-raising for people who couldn’t afford their medical costs. Two of them I particularly remember: one seeking help for a four-year-old who required dental surgery and whose family couldn’t afford the anesthesia, and another for a smiling older couple; the husband had ocular melanoma and could no longer see.

There are three things to recognize about the implementation of the Affordable Care Act and all the criticism of it: First, the Web-site glitches really are a problem. Second, the hearings that Republicans in Congress insist on holding are no way to fix them. Third, when it comes to evaluating the worth of Obamacare we may not remember the Web-site hiccups all that well. What we will remember, and what ultimately matters, is whether, in the next year, the A.C.A. fulfills its promise: to provide affordable health insurance to people who did not have it through an employer, could not afford it on their own, were denied it on the basis of preëxisting conditions, paid more for it than they should have because they were, say, women of child-bearing age, or could no longer get by because their insurance benefits had been capped. In short, people like those on the flyers, who were trying to scrape together the money from neighbors or from passing strangers to pay for health care that they desperately needed.

We’ve all heard a lot about the frustrations of people trying to enroll or just get more information through the balky federal Web site healthcare.gov. When I went on it earlier this week (my husband and I buy our own insurance, so I wanted to comparison shop), I saw a big photograph of a fresh-faced woman in her twenties (signing up young people is job No. 1) and a promising-looking tab labelled “See Plans Now.” But when I clicked on it I got a message that said, “Sorry, we can’t find that page on Healthcare.gov. We’ve recently reorganized our site and that may explain it. It’s also possible that you typed the address incorrectly.” Someone had made the unfortunate decision to preclude browsing on the federal site; until this week, you had to have an account before you could get any information on what insurance might be available to you, and at what cost. As of Thursday afternoon, you could get an estimate through a link to the Kaiser Family Foundation calculator.

Some of the state exchanges allow you to obtain such information earlier in the process, but others follow the federal site’s pattern. A friend who lives in Maryland tried to browse on her state’s site only to find that she had to submit her name and Social Security number and answer a puzzling set of security questions—Where had she lived in third grade? What make of car did she own?—before she could obtain information on the available plans.

As C.G.I., the contractor who designed the site, has said, what healthcare.gov must do is more complicated than most online shopping. It’s also true that C.G.I. should have made the system work much better than it has.

On Thursday, congressional Republicans launched what they said would be a series of hearings, under the auspices of multiple committees, to examine, basically, the Web site. There is something comically out of proportion about that.

If the aim were to make sure that the law is implemented, you would let the administrators work on the technical problems, without screeching at them until they figured it out. You know when that guy from the I.T. department comes to fix your computer? You know how he doesn’t like it when you stand over him, asking ill-informed questions while he’s trying to work? This is basically an I.T. problem; let the I.T. people try to fix it. President Obama this week appointed Jeffrey Zients, his deputy budget director, to supervise the sorting-out of the system. NPR described Zients as “a brainy problem-solver with a knack for cutting bureaucratic knots.” Wish him luck, and be glad you’re not him.

If the problems continue, it may make sense for Congress to delay the imposition of the tax penalty for people who don’t have insurance (ninety-five dollars or one per cent of your income, whichever is higher), which is scheduled to go into effect March 31st (they’ve already been given a little more time). It may make sense to look at the state exchanges, like Kentucky’s and Connecticut’s, that seem to be working especially well. (And I have to say, I noticed improvements on the federal site even between Thursday morning and Thursday afternoon.) It doesn’t make a lot of sense to haul Kathleen Sebelius in for a grilling. When I say sense, I mean, of course, practical sense, not partisan political sense. Republicans in Congress who lost the shutdown battle, and failed to destroy the Affordable Care Act before it came online, are now doing everything they can to bad-mouth and undermine it. This is just the latest, handiest means, though Republicans are openly hoping for more. Representative Greg Walden, of Oregon, said, “If the Web site glitches are just the tip of the iceberg, it’s only a matter of time before the law sinks and takes with it those Democrats who wrote it, voted for it, and are proud of it.”

What matters is what happens after January. That’s when the Americans who are signing up now, or trying to, will be officially covered, and that’s when we can start to answer the most important question: Does Obamacare help the uninsured and the spottily insured? Unless you’re ideologically predisposed to revile the whole enterprise, there’s reason to be hopeful. If only for its guarantees that those with chronic conditions like diabetes and high blood pressure will not be excluded from coverage, and can therefore seek timely and preventive care, the A.C.A. will grant us a measure of compassion and efficiency in our health-care system that did not exist before.

There are real issues there, like the prospect of millions of low-income people who should be getting new coverage under the law but, as things stand, won’t—and not because of a Web site. The Supreme Court ruling that upheld the constitutionality of the Affordable Care Act also allowed states to opt out of one of its provisions: the expansion of Medicaid coverage to people who did not formerly qualify for it, even though they were living below the poverty line. Under the new law, the federal government pays the entire cost to the states of this additional coverage for the first three years, and ninety per cent after that. And yet half the states either declined the feds’ offer or haven’t yet said whether they will take it, which could leave a pretty big hole in the safety net. What will happen to the people poised to fall through it is a pressing question.

Somehow, I don’t think that question will be getting much of an airing in Congress this week. The final word on Obamacare won’t come from the halls of Congress; it will come, for instance, in notes left on bulletin boards in gas stations off the highway, far from Washington.

Photograph by Chris Schneider/Getty

Sign up for the daily newsletter.Sign up for the daily newsletter: the best of The New Yorker every day.